Are the Treatment and Prevention of Obesity Different Problems?

Another trial in the NEJM reported the apparently contradictory failure of the restriction of sugar-sweetened drinks to lead to weight loss by children who were already obese. This suggests that the treatment of obesity and the prevention of obesity might be different problems. Indeed, it would not be surprising if this were so: it is true of most conditions.

Public health is not the only good, however, and the idea of the government interfering in our diets, telling us what we may and may not eat and drink, raises fears of totalitarian nannying. How long will it be before it tells us what we must eat and drink?

An editorial in the NEJM deals with this question by arguing that administrative restriction of unhealthy products is already within the constitutional competence of states. And, unfortunately, there is no simple principle that allows us to draw a clear line between legitimate and illegitimate interference. We cannot demand of nature that it divides phenomena into the neat categories that would make our lives much easier.

We would expect the government to forbid drinks destined to be drunk by children that contained amphetamines, for example, even if the children liked them very much. But how harmful does something have to be, and how immediate the harm, before the government has the right and indeed the duty to step in? It is a question of judgment rather than of principle.

The German novelist Juli Zeh has recently published a novel, The Method, in which health is the last totalitarian dystopia. In the health-totalitarian state, citizens are required to keep themselves healthy and to turn in regular blood results to the health authorities. Sensors in their homes and offices keep track of their heart rates and rhythms; toilets automatically analyse the composition of their excreta. But not every slippery slope has to be slipped down to its bottom.

Fashions in medicine change, partly because new information becomes available. The Dutch trial of artificially sweetened drinks did not consider the possibility that the artificial sweeteners might one day prove to be unhealthy. All that could be said was that 18 months’ consumption of them did not appear to do any harm.